Iquitos

The two things I consistently heard about Iquitos when I mentioned I was going there next:
1. The girls are really hot there and they will try to put pills in your drink and rob you.
2. The weather is really hot.

So far I've avoided being robbed, but everything else seems pretty accurate.

Iquitos definitely has its own personality, but also has a lot in common with your typical South American city. Instead of taxis, here they have motos, 3 wheel vehicles with a covered seat behind for passengers. It feels more touristy than Huancayo and it's much more common to see gringos walking the streets. The locals are a little more forward here and I made a couple of new friends my first night in town who were supposedly just wanting to practice their English. Who knows. It's also much more common to get hit up by beggars, disabled folks and hungry street kids. I try to help when I can but sometimes there are just too many. No clue how Jesus did it...

Cool random fact: about 5 hours away on the river is the leper colony where Che Guvara hung out in Motorcycle Diaries. I thought about going there, but apparently no one lives there anymore.

(warning, it gets gross here. no, really.)
The hospital here is great. Rounds in the morning are very educational and the cases are fascinating. I can add to my repertoire now dengue, malaria, leptospirosis, TB (with and without HIV) as well as your garden variety parasite infections. I also saw probably the most interesting/grossest case of an acute abdomen and surgery that I've ever seen. This guy came in with peritoneal signs and was taken to the OR for presumed appendicitis. Turns out he had an intestinal perforation in the duodenum... from an ascaris... that they found swimming in his abdominal cavity with a buddy. Apparently it's not unheard of, but quite rare. Also ran into a French fellow who was being seen for leishmaniasis and is here as part of a sanitation project for Belen, the floating shanty town a few blocks from my hotel. He was quite a character and we may run into him again to see what he's working on.

I was reading about leptospirosis on UpToDate today and found that the major study on the topic was actually done here in Iquitos. Random. Speaking of research, the two other white folks at the hospital here are doing some cool projects. One is researching malaria transmission from humans to mosquitoes in hopes of finding a vaccine and the other is researching tropical skin infections. She has a lab set up to do cultures and sensitivies and it was kinda fun to see how all that stuff works. It's usually just something that gets ordered and forgotten until the results come back. It's quite a process though.

Tomorrow is match day. I'm kind of excited needless to say, and have spent some good quality time hanging out with God today in preparation. It's all in His hands!

Change of plans

The thing I hate about putting off blogging is that I can't type everything that I want to. Lots of cool stuff this past week but the most interesting and pressing is this:

I have left Huancayo and just bought my plane ticket for Iquitos, a port on the Amazon River in the middle of the jungle.

Yeah, I'm pretty stoked, but it was hard to leave. It's always hard to leave. I met some really great folks in Huancayo including my expat crowd, the doctors and interns, my host family and newly met friends that I never got to know well enough.

This week in the hospital I finally got to see a few surgeries for hydatid cysts which was pretty interesting. One was in a kid of about 11 years old who had two hard-to-access liver cysts. Pretty interesting surgery, but straightforward. I got to do a little more suturing this week on skin, but other than that, it was a pretty typical week of watching surgeries, attending rounds in the mornings and hanging out in the ER in my downtime.

Outside the hospital this week, I took off to play soccer with the surgeons at a doctors' pavilion for recreation. I played goalie and had a few nice saves, but let in a lot of goals too. They ended up hanging out for hours afterward passing around bottle after bottle of Cusquena and telling stories. Not my favorite post-game activity, but later I was invited to a doctor's house for a fantastic meal.

I also ended up over at the expat house one night for crepes courtesy of our French-English friend and met up with my friend from the disco a few nights this week for late-night snacks and conversation. Dr. Montano gave me a great send-off by inviting me over to listen to music and drink some wine. He presented me with a surgery manual in English that he had from training in Cuba... quite a gift!

My host family and I went out for dinner at La Lena (there are about a million of these, but the one on Brena is the best) where I had one more amazing steak before heading out. The next day they prepared an awesome lunch of basically fajita steak, onions and tomatoes and homemade chocolate pudding for dessert!

I met up with Joseph the Peruvian with my backpacks in tow to head out to obtain passage to Lima. I ended up booking with a car instead of a bus because the bus was really expensive during the day and driving in a car is much faster (supposedly) but one broken fan belt later found me sitting on the side of the road between Huancayo and Lima hanging out with my newfound friends, the other passengers in the car, one of whom was a policeman from Lima. Good times.

We finally arrived and I met up with Mario and a big group of his amigas to close the night out with karaoke.

Redeeming a bad Monday (2/2)

Fresh out of the hospital after an unspeakably frustrating morning, I took a long walk home to chill out a little. I spent some time relaxing at the house before calling up a friend to meet up in the park (the Jesus-lovin' gal I met at the discoteca). There was a crowd at the park watching a heated volleyball match and when I asked, it was a team of "maricones" that was dominating. Now there are about a billion words for homosexual in Peru, but maricon (merry-CONE) is the most widely accepted.

My friend and I went for a walk and talked for a while at a juice stand where they basically blend up whatever fresh fruit you want and dump it in a glass. Delish. She had some wise things to say that helped redirect my angst and we discussed our life goals and stuff. Good times. She had to cruise to class that evening and I headed back to the park to try my hand at volleyball.

I watched the conclusion of a match where the maricones again kicked some major butt. It seemed that the winner of the match kept the court and took on challengers. So I hopped down onto the court to see if I could join the next group of challengers. However, as soon as I stepped up, the whole crowd started cheering. Apparently, gringos don't show up to play volleyball a whole lot. As our team slowly formed, one of the reigning champs told me to join their team, as they were one down. If I thought the cheering was loud when I walked on, it was doubled when I stepped onto the other side of the court.

We ended up playing a pretty close match and some really good volleyball. Man, those guys can play. There were definitely a few pretty hilarious moments like when one guy set the ball for me to hit and simultaneously called out "Mi amor!" I'm used to getting teased about the girls here liking me, so it really wasn't that much different and everyone was just out to have fun and joke around. We ended up winning, and apparently there was some money on the game because I came away 1 sol richer. I wasn't a standout player and made my share of mistakes, but also got a few nice spikes in. They invited me back at least...

Afterward I met up with my gringo crew at a pizza joint downtown for some good times and okay pizza. My friend finished her classes and took me to a bar with live Peruvian music and colchitas (kind of like spiced rum) for a nightcap before I tucked in for the night.

It was a long day and the stark contrast between my morning and my afternoon still surprises me a bit, but I'm thankful that the pain of my lesson in humility from that morning was far outshone by the richness and the fullness of engaging in the lives of the beautiful diversity of people that God has made.

Lessons in Humility strike again (1/2)

Ever have those days when you know what you're supposed to learn from the hard things you're facing, but you just don't care and you want it to be made right??

Welcome to Monday. Having been here for 3 weeks, I assumed I would be given a bit more liberty in the OR and much to my delight, I was offered the opportunity to assist on thoracic cases... on Monday.

Up to this point, I've gotten to assist only a couple times, with the majority of my time being spent watching and leaning over the surgeon to help retract. Reminiscent of shadowing a physician during my 1st year of med school. In contrast, during my surgery rotations this year, I've done a below-the-knee amputation myself and assisted on neck dissections, opening the chest for heart surgery and multiple thoracic surgeries, not to mention doing a fair amount suturing upon closure for most cases. Coming to Peru, I was hoping to get even more hands-on experience while learning about endemic diseases.

So I showed up, on Monday, ready to get my hands a little dirty, but when I walked into the OR, the patient wasn't in the room. When I check again, they still were there... 30 minutes... 45 minutes... an hour... hour and a half and no patient. In fact, the surgeon that I'd met and was planning to operate with was nowhere to be seen either. I finally got up and sought out the anesthesiologists. They essentially told me that all of the thoracic cases were canceled for the day. Upon further inquiry, they informed me that thoracic cases are complex and they should have two real surgeons operating for all of them.

I wanted to scream in their faces that I have assisted on thoracic cases at the Oregon Health Sciences University Hospital and if I was good enough there, I should be good enough in Huancayo, Peru.

I managed to keep cool for the most part, but when one of the interns graciously offered to let me watch another laparoscopic gallbladder surgery, I should have said thank you and scrubbed for the surgery. But I told him, instead, that at this point, I don't have the humility to stay and watch anymore. He understood the situation. I left.

In speaking with my attending about the situation later, he explained that allowing me to assist is not necessarily illegal, but is borderline, and he believes that there was some concern about litigation. Still. It stung.

Fin de semana #4 - R&R vs R&B

I had planned to stay in Huancayo anyway, but when fever struck Thursday night, thoughts of fleeing the city for the weekend vanished. I was bummed to call in sick on Friday because a pancreas specialist was visiting for the weekend, events to include a dinner on Friday, rounds on Saturday and some teaching on the subject. So instead, I spent Friday sleeping/watching movies/sleeping and trying to pretend like I wasn't there. My host family finally discovered me late in the day and did their best to coddle me, which I resisted only half-heartedly.

Saturday saw much improvement and having reassured myself that I didn't have anything scary like TB or malaria, I headed over to my attending's house for lunch... or so I thought. As it turns out, he's somewhat of a gourmet and I arrived to find pork glazed in honey smoking in a homemade contraption in the back yard. His house is beautiful, with a garden in front and back with all kinds of interesting, edible plants that I can't begin to remember the names of.

However, for him, being at home on Saturday does not necessarily mean not working. Across his back lawn is the back entrance to a clinic that he shares with his wife, a dermatologist. Throughout the afternoon, patients would drop by for appointments or check-ups and he would duck out for a few minutes. Later in the day, he told me to come with him and we wound up in a private clinic doing a hernia operation on Saturday afternoon.

As I was watching, it gave me room for pause. My ideal career consists of working really hard some times and playing really hard at others, hopefully helping people along the way. His life is nigh consumed by surgery and patients, even in his free time. When I questioned how he manages this, he replied that he does what is necessary to support his family both here and in Cuba. It was quite sobering.

Saturday evening, I headed over to a gathering of a bunch of expats at the house of my friends from the jungle trip. It was a great night of hanging out, drinking wine (Romanian pinot?), eating lasagna made by my British rockstar friend (to be fair, he hasn't made it yet, but his music is fantastic) and hearing stories from all over the world. We had folks from France, Bermuda, England, Ireland, the U.S. and Peru all converging over dinner. Excellent.

Nighttime found us trying out a new discoteca, La Noche, which was a flop so we moved on to familiar haunts, a discoteca they frequent frequently and I'd been to once, Taj Mahal. In addition to a great night of dancing, later on, I was recruited to meet a couple of Peruvian gals with my British buddy. As is prone to happen, the girl I danced with asked why I was single, but when I started talking about my faith, instead of a blank stare, her eyes lit up. We ended up talking quite a bit and we have pretty similar stories and love for God.

Not that such coincidences are unheard of, but it is rare to meet some one in Peru that loves God but can still go out dancing and have a glass of wine or two. Anyway, it was super great to meet some one had a genuine love for God and was excited to talk about it! God must have known that my Monday was going to be really frustrating and I'd need some encouragement. More on that later.

Sunday I slept in and then headed back over to Dr. Montano's house for a lesson in making ceviche, a Peruvian delicacy. We hit up the market to buy supplies and that was an experience itself. He had fewer patients on Sunday and I slipped out a little early to spend time with the expat crowd. They'd had a barbeque that was winding down when I got there, but the music was winding up. I was treated to live performances by my British friend, the gal from Bermuda who sings some mean blues without accompaniment and the local on guitar and wooden flute, which is in a lot of Peruvian music.

I winded down the night with a walk to the central plaza. Snagged a burger and fries and sat down to eat and think and pray. Got accosted by a group of Peruvian gals on vacation who all wanted pictures with a gringo. Back to prayer & meditation. Reenergized. Back to the casa for a conference call with my college roommates over Skype to finish off the night and me.

The Daily Grind

The alarm clock is set for 7 a.m. (which means I roll out of bed at about 7:20) and breakfast is waiting downstairs. The initial offerings included fruit, eggs and avocado, but the family I'm staying with has since realized that I really only eat a piece of bread and drink a cup of coffee (instant coffee, sugar, milk & hot water). If I'm feeling ravenous, I'll stack on some jelly or a piece of cheese. I'm out the door at 7:45 and walk less than a block to the main road through Tambo. Huancayo proper is actually a bit to the south of my place. It usually takes a couple minutes to spot a legit taxi looking for a fare. The price to the hospital is 3 soles, which equates to about a dollar.

Five minutes later I'm at the entrance to the hospital, greeting the security guards at the gate, walking through the courtyard and I head to my daily work. Since obtaining my white coat from Dr. Montano, none of the guards have really questioned my right to be there and give me confused looks when they ask my last name, but let me by.

Mondays, Wednesdays and Fridays I'm in the OR all day with the general surgeons. Occasionally I'll check out other surgeries. This week I stepped in on an emergency GYN surgery for a ruptured ectopic pregnancy (lots of internal bleeding) and a revision of a nasty tibia fracture. I don't do anything, just watch. Wednesdays I scrub in with the pediatric surgeons and usually get to help out a bit. This week we removed a 10 pound ovarian tumor from a 13 year old. It was ugly.

I suppose it was the arrogant American in me that assumed I would walk in and get to operate or have a pretty active role in the OR, but there are usually two surgeons on all general surgeries and they work 12 hour days doing nothing but operating. I share 2nd assist duties with the interns here. On simple surgeries, I sometimes first assist and actually got to head up removing a fatty tumor from a guy this week. It has tested my patience to sit and watch surgeries that I've seen a lot of already, but I will be there soon enough.

Tuesdays and Thursdays I generally tag along for morning rounds with the surgeon of the day and the intern covering the surgery floor. After rounds I help with dressing changes, wound care and sometimes head down to the ER to hang out with a doc down there. Dr. Carlos is a medicine doc that is pretty proficient in English and enjoys the chance to practice, so I've been hanging out with him in the ER when he's on. I actually learn quite a bit of medical Spanish from him as well.

I'm usually out the door before 5 on non-OR days and today I came home for a nap, which wiped me out for the rest of the day. I walked downtown to see if I could catch a movie at the mall, but the one I wanted to see was in Spanish rather than in English with subtitles. Sometimes I just need a break from stumbling through Spanish.

So instead, I ate dinner at the mall food court and then headed to the central plaza/park and just hung out. This may sound kinda corny, but tonight was kind of a date with God. I haven't been doing so hot on spending time with Him lately and tonight was a great chance to just relax and enjoy the presence of my Creator.

This weekend is looking like it will be full even though I'm probably staying in Huancayo. I'm okay with that, especially considering that I have a potential grand adventure in the works...

Fin de semana #3 - Welcome to the Jungle

La Merced was the destination. The group consisted of 3 girls I'd run into in a restaurant while out with the doctory type, a Huancayino and an English rockstar. The girls were from Maryland, N. Carolina and France/England and are here volunteering at an orphanage. After a quiet Friday night at home for me, we met up at the bus terminal on Saturday a.m. to commence our journey.

The rest of the crew was wiped out from dancing until 4:30 in the morning, but somehow managed to rally for an 8 a.m. bus ride. I was so proud. So we talked briefly before most of the crew passed out on the bus. I enjoyed the beautiful scenery between Huancayo and La Merced and tried to sleep when the turns got a little too twisty.



Upon arrival in La Merced, we snacked (a popular pastime with this group), they slept, I visited a local hospital and we embarked on a beautiful hike through the jungle to a waterfall. We made it back that night in time to eat and experience a small amount of the city life before tucking in for the night.



We arranged for a guided tour on Sunday, which I will admit I was not a huge fan of, but I was following the crowd. It turned out pretty great. We learned about local history, agriculture, native groups and such. We even visited an "authentic native village" where we were greeted with traditional clothing, a story, dancing and exotic animals. Afterward, we were expected to buy souvenirs and stuff, but I didn't. I did pay 50 cents to have my picture taken with an exotic rodent (pacarana) eating an ice cream though.



Finally, we got down to business and headed way out of town to hike up to another waterfall that was pretty spectacular. We went swimming despite the coolish temperatures and I got a great massage from the cascading water. I also managed to take a fall off a boulder that I was climbing, but our guide, Jesus (hey-SOOSE), was there to catch me and I wasn't hurt a bit. Anyone care to comment on this irony???



There was tons more that happened over the weekend, but it was little stuff, like getting yelled at about nutritional supplements on the bus, riding on the back of a moto taxi, trying to make animal-shaped balloons in the pub, countless jokes with new friends about American vs British culture, eating giant rodents, finding obscure bands in common with people from across the pond, driving through a river on a cliff and hoping the bus wouldn't slip and planning our next escapade. Believe me, it's in the works, and it very well may involve snacking.